Maggio 2002 - Volume XXI - numero 5
Focus
Gastroenterologia ed Epatologia Pediatrica, I Divisione di Pediatria, Dipartimento di Medicina della Procreazione e dell’Età Evolutiva, Università di Pisa
Key words: Cholestasis, Epstein-Barr virus (EBV), Infectious mononucleosis
Although biochemical evidence of liver damage is frequent in children with EBV infectious mononucleosis, signs or symptoms related to an impaired bile flow as jaundice or pruritus are rare. The Authors report three cases observed in a two-year period with acute EBV infectious mononucleosis presenting with cholestasis and abrupt onset, and describe findings of a retrospective review for evidence of liver involvement of 54 children with EBV related infectious mononucleosis. Biochemical evidence of liver damage was present in 27 patients with two patterns: isolated increase of aminotransferase with normal serum γ-glutamyl transpeptidase (γGT) activity in 16, and simultaneous increase of aminotransferase and γGT activity in 10. All patients recovered within a period of 2 weeks to 3 months. EBV infection may start with cholestasis with a biochemical pattern characterised by a significant increase of γGT, but a moderate increase of aminotransferase. Elevation of γGT in EBV infectious mononucleosis suggests a virus-induced, self-limited cholangiocyte damage.
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